Hypertension in pediatric patients with chronic kidney disease: management challenges

Abstract

Claire M Gallibois,1,2 Natasha A Jawa,1 Damien G Noone1 1Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada; 2Faculty of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland Abstract: In contrast to adults where hypertension is a leading cause of chronic kidney disease, in pediatrics, hypertension is predominantly a sequela, however, an important one that, like in adults, is likely associated with a more rapid decline in kidney function or progression of chronic kidney disease to end stage. There is a significant issue with unrecognized, or masked, hypertension in childhood chronic kidney disease. Recent evidence and, therefore, guidelines now suggest targeting a blood pressure of <50th percentile for age, sex, and height in children with proteinuria and chronic kidney disease. This often cannot be achieved by monotherapy and additional agents need to be added. Blockade of the renin angiotensin aldosterone system represents the mainstay of therapy, although often limited by the side effect of hyperkalemia. The addition of a diuretic, at least in the earlier stages of chronic kidney disease, might help mitigate this problem. Keywords: chronic kidney disease, end-stage renal disease, hypertension, pediatrics, blood pressure, ambulatory blood pressure monitoring, obesity

Keywords

• Chronic Kidney Disease
• End stage renal disease
• Hypertension
• Paediatrics
• Blood pressure
• Ambulatory blood pressure monitoring
• obesity